For Single Dosing, Levofloxacin Is Superior to Ciprofloxacin When Combined With an Aminoglycoside in Preventing Severe Infections After Prostate Biopsy

Unnikrishnan, Raman; Elshafei, Ahmed; Klein, Eric A.; Jones, J. Stephen; Kartha, Ganesh; Goldman, Howard B.

doi:10.1016/j.urology.2014.12.062

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…Recently, a single report revealed that another FQ, levofloxacin, showed good efficacy compared to that of ciprofloxacin. 23 Unnikrishnan et al 23 reported a reduction in post-biopsy infectious complications in a severe case after changing the prophylactic antibiotics from ciprofloxacin to levofloxacin. Both FQs were used in combination with an aminoglycoside, and levofloxacin was chosen because it has a longer half-life and higher oral bioavailability than ciprofloxacin.…”

Section: Discussionmentioning

confidence: 99%

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

et al. 2018

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BackgroundTo investigate whether addition of amikacin to fluoroquinolone (FQ) antimicrobial prophylaxis reduces infections after transrectal ultrasound-guided prostate biopsy (TRUSPB).MethodsA total of 503 patients undergoing rectal swab were divided into three groups. Patients with FQ-sensitive rectal flora (group 1, n = 248) were administered ciprofloxacin before TRUSPB, and patients with FQ-resistant rectal flora were either administered ciprofloxacin (group 2, n = 97) or amikacin and ciprofloxacin (group 3, n = 158) before TRUSPB.ResultsBased on the rectal swab, FQ resistance was 54.9%, and extended-spectrum β-lactamase (ESBL) positivity was 17.2%. The incidence of infectious complication in group 1 was 1.6%. Groups 2 and 3, with FQ-resistant rectal flora, tended to have increased infectious complications (5.2% and 4.4%, respectively) but the difference between those results is not statistically significant. The most common pathogens of infectious complications in patients with FQ-resistant rectal flora were FQ-resistant and ESBL-producing Escherichia coli. E. coli pathogens isolated in Group 3 were amikacin-susceptible species. The operation history and ESBL positivity of rectal flora increased the incidence of infectious complications (odds ratio [OR] = 3.68; P = 0.035 and OR = 4.02; P = 0.008, respectively). DM and antibiotics exposure were risk factors for FQ resistance (OR = 2.19; P = 0.002) and ESBL positivity of rectal flora (OR = 2.96; P = 0.005), respectively.ConclusionAddition of amikacin to ciprofloxacin prophylaxis could not reduce infectious complications in patients with FQ-resistant rectal flora. Despite the amikacin sensitivity of infectious complications, single-dose amikacin addition to ciprofloxacin prophylaxis has limitations.

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Section: Discussionmentioning

confidence: 99%

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

et al. 2018

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“…Fluoroquinolone resistant organisms have been identified in 10-30% of patients undergoing rectal swab culture before PB 47,[49][50][51][52] , although rates of clinical infectious complications are lower at approximately 1-17.5% 7,45,46,48,[53][54][55][56][57] . Most infections are self-limiting and can be managed in the outpatient setting 7,45 .…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

“…Similarly, adding intramuscular amikacin 75 , gentamicin 76 , ceftriaxone 68 or amoxicillin-clavulanate 77 to fluoroquinolones have been shown to reduce infectious complications after TRUS-guided PB. Others have reported favorable results by switching from ciprofloxacin 500 mg plus aminoglycosides to levofloxacin 750 mg plus aminoglycosides 78 , by mixing 1 gram of ceftriaxone into the periprostatic lidocaine injection 79 or by combining intramuscular cephalosporin with povidone-iodine suppositories 57 . A growing body of nonrandomized studies support rectal swab-targeted prophylaxis for transrectal PB.…”

Section: Infectious Complications and Hospitalization Rates After Promentioning

confidence: 99%

Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…The routine dose is 200mg each time with two doses per day (Stein et al, 2008;Unnikrishnan et al, 2015). Pharmacokinetic (PK) and pharmacodynamic (PD) studies of many antibacterial drugs (including quinolone) are deepening continuously.…”

Section: Introductionmentioning

confidence: 99%

The analysis of the effectiveness and safety of levofloxacin in the treatment of lower respiratory tract infection

Alreshidi¹,

Al-Mutairi

Han³

2015

Int Curr Pharm J

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Objective of the current study was to investigate the effectiveness and safety of levofloxacin in the treatment of lower respiratory tract infection. The study was carried out in hospital on 120 patients with lower respiratory tract infection from January 2014 to January 2015. Patients were randomly divided into control and observation groups, each group contained 60 patients. The control group was given the routine dose of levofloxacin, whereas the observation group received the high dose of levofloxacin. The clinical effectiveness and incidence rate of untoward reactions between the two groups were statistically analyzed and evaluated. Patients cure rate in the observation group was 53.33%, significantly higher than that of the control group which was only 36.67%. Their differences have statistical significance (P<0.05). Observation group demonstrated a very good total effective rate of 93.33%, compared to the control group (78.33%). Their differences have statistical significance (P<0.05). Incidence of adverse reactions in case of both the observation and control group patients, were relatively low, resulting insignificant statistical difference between the groups (P>0.05). This study shows better clinical curative effect of high doses of levofloxacin treating lower respiratory infection with minimum risk. This method, which can significantly improve the quality of patient treatment with low adverse reaction risk, is worth popularizing in clinical use.Alreshidi et al., International Current Pharmaceutical Journal, November 2015, 4(12): 462-464

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For Single Dosing, Levofloxacin Is Superior to Ciprofloxacin When Combined With an Aminoglycoside in Preventing Severe Infections After Prostate Biopsy

Cited by 12 publications

References 11 publications

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora

Complications After Systematic, Random, and Image-guided Prostate Biopsy

The analysis of the effectiveness and safety of levofloxacin in the treatment of lower respiratory tract infection

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